Influencia de la “diplomacia militar” en las fuerzas armadas chilenas durante la temprana guerra fría 1942-1952

The authors characterize a period of the civil – military relations in Chile previous to the crisis of 1973. It is the period between 1942 and 1952 to apply a concept of “military diplomacy” and to describe the professional autonomous relations between the armed forces of Chile and the United States. This allows us to check Huntington's professionalism model, as even though these contacts between the Armed Forces relate in a professional level, by means of the military American assistance, in the frame of Pan-American cooperation, conformity takes place between the Chilean and the American strategic perspectives. All of this inside a formal subordination in terms of civil – military relations. This allows the Chilean military personnel in charge to communicate, at the level of the political conduction and of the Ministry of Foreign Affairs of Chile, their proposals reconciled with the military commanders.Los autores caracterizan un periodo de las relaciones civiles-militares en Chile anterior a la crisis de 1973. Es el periodo comprendido entre los años 1942 y 1952 para aplicar un concepto de "diplomacia militar" y describir las relaciones profesionales autónomas entre las fuerzas armadas de Chile y Estados Unidos. Esto nos permite verificar el modelo del profesionalismo de Huntington, pues si bien estos contactos entre las Fuerzas Armadas se relacionan en un nivel profesional, mediante la asistencia militar estadounidense, en el marco de cooperación panamericana, se produce una concordancia entre la perspectiva estratégica chilena y la estadounidense. Todo dentro de una subordinación formal en términos de relaciones civiles-militares. Esto les permite a los mandos militares chilenos comunicar a nivel de la conducción política y del Ministerio de Relaciones Exteriores de Chile sus propuestas concordadas con mandos militares de EE.UU

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)